Attenuated Pulse Pressure Recovery Following Orthostatic Stress in Patients with Long COVID-19

Ana Leticia Gomes dos Santos1, Kelly Correa Baioco Da Silva2, Stella Tassinari Maximo3, silvia helena bastos de paula4, Jose L Puglisi5, Daniel Gustavo Goroso1
1University of Mogi das Cruzes, 2Universidade Mogi das Cruzes, 3Sao Leopoldo Mandic, 4Instituto de Saúde/SesSP, 5California North State University


Abstract

Long COVID-19 has been associated with autonomic dysfunction and abnormal cardiovascular responses to postural stress. This study evaluated pulse pressure (PP), heart rate variability (HRV), and baroreflex sensitivity (BRS) during a standardized tilt table test in 56 participants with complete data (37 Long COVID-19; 19 controls). The protocol comprised 15 min supine rest, 15 min at 75° upright tilt, and 20 min supine recovery. During upright tilt, the Long COVID-19 group showed a longer mean RR interval (p=0.035) and lower LF/HF ratio (p=0.0316). PP recovery after return to supine was attenuated (8.0 vs. 11.8 mmHg; p=0.033), whereas estimated BRS did not differ significantly between groups. These findings indicate impaired cardiovascular recovery after orthostatic stress and support dynamic pressure analysis as a complementary marker of cardiovascular dysregulation in Long COVID-19.